Rural-urban differences in HIV viral loads and progression to AIDS among new HIV cases

South Med J. 2015 Mar;108(3):180-8. doi: 10.14423/SMJ.0000000000000255.


Objective: The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in the United States has shifted to the South, where an increasing proportion is occurring in rural areas. We sought to gain a better understanding of the affected rural population in this region.

Methods: The statewide HIV/AIDS Electronic Reporting System database was used to examine the epidemiological characteristics of newly diagnosed HIV cases in South Carolina from 2005 to 2011. Rural-urban differences were examined in sociodemographic and clinical characteristics, including progression to AIDS and a decline in HIV viral load (VL) to undetectable levels within 1 year of diagnosis.

Results: Of the 5336 individuals newly diagnosed as having HIV, 1433 (26.9%) were from rural areas. Compared with urban residents, a higher proportion of rural residents were black, non-Hispanic (80.1% vs 68.5%; P ≤ 0.0001) and reported heterosexual risk (28.8% vs 22.9%; P = 0.0007). The proportion of female patients was higher in rural areas (29.7% vs 26.4%; P = 0.016). No significant rural-urban differences were found in initial CD4(+) T-cell and VL counts or proportion obtaining an undetectable VL at 1 year. Rural residents were significantly more likely than urban residents to have AIDS at diagnosis or within 1 year of the HIV diagnosis (adjusted odds ratio 1.15; 95% confidence interval 1.007-1.326).

Conclusions: The reasons behind differences in proportions of rural and urban residents who were diagnosed as having AIDS or progressed to AIDS despite similar initial CD4(+) T-cell counts and VL suppression at 1 year are unclear and should be explored in future studies. Future prevention and treatment efforts may need to consider the unique characteristics of rural populations in the South.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / epidemiology*
  • Acquired Immunodeficiency Syndrome / virology
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Disease Notification
  • Disease Progression*
  • Female
  • HIV Infections / diagnosis
  • HIV Infections / epidemiology*
  • HIV Infections / virology
  • Health Status Disparities*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Rural Health / statistics & numerical data*
  • Socioeconomic Factors
  • South Carolina / epidemiology
  • Urban Health / statistics & numerical data*
  • Viral Load*
  • Young Adult